"[The DOL's] 2022 Mental Health Parity and Addiction Equity Act (MHPAEA) Report to Congress  ... found that plans were not complying with the new comparative analysis requirement for non-quantitative treatment limitations (NQTLs) added by the Consolidated Appropriations Act of 2021.... This post provides plan sponsors with a high-level overview of the NQTL rules, significant issues identified by the DOL in the Report, and what sponsors can do to prepare for the on-going enforcement efforts."   MORE >>

"The federal [independent dispute resolution (IDR)] process is administered through the federal IDR Portal . The federal IDR process is complicated and will be challenging for anyone to comply with, but it can be broken down into the [roughly ten] steps."   MORE >>

"The court explained that the mere receipt of bulk-billing payments does not automatically make an insurer a fiduciary but here, the policy and Reliance's practices make it a relevant fiduciary.... Reliance had a duty of loyalty to verify that premiums it received came only from eligible, enrolled employees.... Allowing Reliance to escape liability because it designed a faulty enrollment system would endorse willful blindness." [ Skelton v. Radisson Hotel Bloomington , No. 21-2641 (8th Cir. May 6, 2022)]   MORE >>

"Consumers have grown bullish about receiving more of their healthcare at home.... Providers and consumers may be misaligned on how telehealth should be used.... 18-24 year olds have been most affected by the mental health impacts of COVID-19. Here's where they are turning for help.... The pandemic fire-tested new strategies for clinical trials. Will moving trials out of the hospital help boost enrollment?"   MORE >>

"Employee leave is complex. And while offering options to replace income is a great start, it's only the beginning.... Employees want support and education.... Employees struggle to find information that's clear, comprehensive.... A negative employee experience can create a poor employer perception.... The return-to-work experience is as important as the leave."   MORE >>

"[A] value-based approach would prevent Medicare from overpaying for drugs that provide little or no improvement in health relative to alternative therapies and free up resources to invest in worthy alternatives.... Private payers and some state Medicaid programs already turn to value assessments to understand whether new treatments, particularly those with high price tags, are worth the investment."   MORE >>